Medicare Advocates Asking Congress For Stronger Network Assurances

Medicare advocates urge Congress to pass legislation that would provide more guarantees around physician netwo

Medicare advocates said Tuesday that patients deserve protections included in legislation introduced in June by Connecticut members of Congress.

The Center for Medicare Advocacy and the Medicare Rights Center held a phone conference with U.S. Rep. Rosa DeLauro, D-3rd District, and U.S. Sen. Richard Blumenthal, D-Conn., to talk about legislation introduced by each on June 26.

The Medicare Advantage Participant Bill of Rights Act, being reviewed by committees in the House and the Senate, has a number of goals, including the following :

— To prevent insurers from removing doctors from their Medicare Advantage networks without cause in the middle of the year.

— To require insurers to lock in Medicare Advantage networks 60 days before annual enrollment.

— To provide more notice and information to beneficiaries regarding network changes.

Blumenthal said, "Here we are in need of new laws that assure compliance and protection for patients, and that's the basic goal here. The network narrowing that is a constant threat, the abuses that are potentially ever present, has to be corrected and stopped, and this legislation would do it."

Last fall, UnitedHealthcare told an unspecified number of doctors they would be dropped from the insurer's Medicare Advantage network in early 2014. The Fairfield County Medical Association said the change reduced UnitedHealthcare's Connecticut network by 810 primary care physicians and 1,440 medical specialists.

About 30 doctors in the New Haven area were no longer part of UnitedHealthcare's Medicare Advantage network on July 1. UnitedHealthcare and Yale-New Haven Hospital failed to agree on terms for treating the insurer's Medicare Advantage patients. The hospital has been out of network for those patients since April 1.

"UnitedHealth Group dropped an unprecedented number of doctors from their Medicare Advantage networks," DeLauro said. "I met with seniors in my district several times to talk about the effect this was having … [customers] were cast adrift, if you will, not knowing what they were going to do."

UnitedHealthcare spokeswoman Jessica Pappas said in a statement, "We continue to offer Medicare Advantage enrollees a broad choice of primary care physicians and specialists in Connecticut and elsewhere, and are committed to ensuring Medicare beneficiaries have access to quality, affordable care."

More than 10,000 Americans signed a petition sponsored by the Medicare Rights Center, the Center for Medicare Advocacy and the National Physicians Alliance, calling on Congress to support the bill.

"With baby boomers continuing to age, a strong Medicare program is more important than ever before," Medicare Rights Center President Joe Baker said in a statement. "We need Congress to pass this bill to provide a basic measure of health security to our nation's seniors, regardless of what Medicare program they choose."